Accepted for/Published in: JMIR Research Protocols
Date Submitted: Aug 1, 2025
Date Accepted: Mar 23, 2026
The Role of Electronic Medical Record Systems and Pharmacovigilance Databases in the Surveillance of Antimicrobial Use and Resistance in Low- and Middle-Income Countries (EP-AMR): Protocol for a Multi-Study Project
ABSTRACT
Background:
Addressing antimicrobial resistance (AMR) requires proactive and innovative approaches in the digital world. The absence of comprehensive AMR data in low- and middle-income countries (LMICs) emphasizes the need for enhanced surveillance systems. Electronic Medical Record (EMR) systems and Pharmacovigilance (PV) databases demonstrate the potential of technology in AMR surveillance.
Objective:
This project aims to assess the implications of using digital tools, specifically EMR systems and PV databases, for the surveillance of antibiotic use and resistance patterns in LMICs.
Methods:
The project comprises five studies focusing on the use of EMR systems, PV databases, and other digital tools for antimicrobial resistance surveillance, along with an examination of healthcare professionals’ practices. The first study aims to assess healthcare facilities and professionals’ experiences and preparedness in India regarding EMR system implementation and its impact on antibiotic use and resistance surveillance. Data collection involves self-administered questionnaires and interviews in settings with and without an implemented EMR system. The second study is to investigate the implications of utilizing PV databases for detecting antibiotic resistance trends and antibiotic misuse, by analyzing antibiotics’ adverse drug reaction (ADR) reports submitted to the VigiBase database. The third study aims to assess healthcare professionals’ knowledge, attitudes, practices, and perceived barriers related to PV and ADRs reporting associated with antibiotics in India. The fourth and fifth studies are a systematic review of using the PV databases and EMR system for antibiotic resistance surveillance in LMICs, evaluating their utilization and exploring any other digital interventions.
Results:
The project is ongoing: For Study 1, 500 participants are enrolled using the self-administered questionnaire and 38 interviews with healthcare professionals were conducted; for Study 2, data have been received in soft copies, but the analysis have not been started; for Study 4, screening of articles is ongoing and the study is registered at PROSPERO International Prospective Register of Systematic Reviews, registration no. CRD42024578136; and Studies 3 and 5 are scheduled for 2026. The project is partly funded by the Research Council of Norway with Project number 325985 and the Swedish Research Council with project number 2021-00889.
Conclusions:
The digital tools such as EMR systems and PV databases can play a crucial role in collecting more data about antibiotics use and AMR. This project emphasizes the importance of multidimensional solutions and explores the implementation of PV and EMRs in LMICs for effective AMR surveillance. Leveraging these digital systems offers an opportunity to enhance knowledge and strengthen efforts in the fight against AMR. Clinical Trial: Study 4 is registered at PROSPERO International Prospective Register of Systematic Reviews, registration no. CRD42024578136
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